Anatomic Terminology and Nomenclature of the Paranasal Sinuses and Quantification for Staging Sinusitis

I. Introduction 188

II. Embryology of the Lateral Nasal Wall 189

III. Anatomical Philosophy 190

IV. Ethmoid Sinuses 190

V. Basal Lamella of the Middle Turbinate 190

VI. Anterior Ethmoidal Region 192

A. Uncinate Process 192

B. Agger Nasi 192

C. Ethmoid Bulla 193

D. Retrobullar and Suprabullar Recess 193

E. Hiatus Semilunaris 194

F. Ethmoid Infundibulum 194

G. Maxillary Sinus Ostium 194

H. Nasal Fontanelles 194

I. Frontal and Maxillary Infundibula 195

J. Ethmoid Roof 195

K. Anatomical Variants of the Anterior Ethmoid 195

L. Ostiomeatal Complex 196

VII. Frontal Recess and Frontal Sinus 197

A. Supraorbital Ethmoid Cell 198

B. Frontal Cells 199

VIII. Posterior Ethmoidal Region 199

A. Posterior Ethmoid Cells 199

B. Sphenoethmoidal Recess 199

C. Sphenoethmoid Cell 199

D. Optic Nerve Tubercle 200

IX. Quantification for Staging 200

A. Overview-The Need for Staging Systems 200

B. Objective Measures/Staging Systems for Sinusitis 201 Prognostic Factors, Outcomes, and Staging-The

Kennedy System (10) 201

The Need for a More Comprehensive System 202

The Modified Lund-MacKay System (AAO-HNS

Rhinosinusitis Task Force) 202

C. Subjective vs. Objective Evaluation-Significance for

Prognosis 206

D. Subjective Evaluation Scales-Outcomes Research 206

References 207

I. Introduction

The last 15 years has seen a tremendous advance in the technology available for

the diagnosis and treatment of paranasal sinus disease. The resolution of current

imaging techniques and the level of surgical precision provided by endoscopic

techniques are unparalleled in history. The opportunity for precise surgical inter-

vention makes accurate communication between radiologists and surgeons

imperative. Therefore the need for standardized anatomic nomenclature is essen-

tial. Additionally, international communication between otolaryngologists would

be greatly facilitated by a uniform system for anatomic terminology. Further,

detailed knowledge of paranasal sinus anatomy forms the basis for the current

understanding of the pathophysiology of sinus inflammatory disease.